Journal of special operations medicine : a peer reviewed journal for SOF medical professionals最新文献

Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is used in trauma patients with pulmonary injury in the acute setting. The United States Military has an advanced ECMO transport and management capability; however, future conflicts may require forward prolonged casualty care (PCC). Special Operations Surgical Teams (SOSTs) provide damage control surgery, resuscitation, and PCC in forward, unregulated, multidomain environments. We hypothesize that SOSTs can be trained to cannulate and manage patients requiring VV ECMO.

Methods: We developed a 2.5-day course using knowledge assessments (25 questions), self-assessments (5-point Likert scale, moderate confidence=3), and instruction checklists. The instruction checklists were used to assess performance during final evaluation with Yorkshire swine (Sus scrofa) models. Data were tested for normality, and statistical significance was defined as P<.05.

Results: Twelve qualified SOST personnel completed the training. Four participants reported previous ECMO clinical exposure, and none reported formal ECMO training. When comparing pre- and post-course knowledge assessment scores, there was a significant improvement in overall scores (12.5 vs. 20.6, P<.001). The number of participants who self-reported at least moderate confidence in cognitive (2.8 vs. 11.3, P<.001), technical (1.2 vs. 11.6, P<.001), and behavioral (2 vs. 12, P<.001) aspects of VV ECMO set-up, cannulation, and management increased. Each team successfully set up, cannulated, and managed models with lights on and in darkness.

Conclusions: In a cohort of United States Air Force SOST personnel, using a modified training curriculum with 2-hour, hands-on validation testing improved self-assessment and knowledge assessment scores in performing VV ECMO. Given the rise of extracorporeal support use in the care of medical and trauma patients and the possibility of PCC in the military population, forward VV ECMO training and sustainment should be studied further.

This article highlights key topic areas related to dietary supplements (DSs) and performance-enhancing substances. It also discusses evidence-based resources the medical community can use when discussing high-quality DSs with Servicemembers interested in taking DSs. We briefly overview how DSs are regulated in the United States, discuss problematic categories and issues related to quality, expand upon what are often considered performance-enhancing substances yet sometimes sold as DSs, and then offer solutions to counter the consequences of the dark side of the DS industry. Solutions include third-party certification and intentional education and resources, as military health care providers and medics need to know where to go for evidence-based information, per the Department of Defense Instruction 6130.06 - Use of Dietary Supplements in the DoD (DoDI 6130.06), which set policy and guidelines for Servicemembers in 2022. Finally, Operation Supplement Safety (OPSS) resources and tools are discussed.

Background: Detection of retained foreign bodies (FB) is a difficult task in both austere environments and emergency departments, particularly when they are radiolucent and not detectable by plain radiographs. Failure to identify and remove them can lead to increased morbidity.

Objective: To determine the accuracy of Special Forces (SF) medics in detecting wooden FBs in tissue models, using point-of-care ultrasound.

Methods: A prospective, single-blinded, observational study using chicken thigh models was performed. Medics with no prior soft-tissue ultrasound experience received a 1-hour lecture on ultrasound, then scanned 10 tissue models for up to 3 minutes each. Participants were blinded to the models: five were free of FBs and five contained a single wooden FB of varying lengths (1, 2.5, 5, 7.5, or 10mm) at a depth of 5mm.

Results: Twenty SF medics performed 200 total scans. For the detection of wooden FBs, sensitivity was 71.8% (95% CI 50.7-85.7) and specificity 82.0% (95% CI 61.1-92.6). The 10-mm FB was identified with 95% accuracy and had an overall sensitivity of 95% (95% CI 76.4-99).

Conclusions: SF medics with minimal ultrasound training are capable of accurately identifying soft-tissue wooden FBs with ultrasound. The FB size, orientation, and proximity to fibrous tissues were important factors in accurate identification. SF medics use of ultrasound to aid in the detection of superficial, soft-tissue FBs is an obtainable and valuable skill.

Introduction: A systematic radiological examination is needed for military airborne troops in order to detect subclinical medical contraindications for airborne training. Many potential recruits are excluded because of scoliosis, kyphosis, or spondylolisthesis. This study aimed to determine whether complementary radiological assessment excludes too many recruits and whether medical standards might be lowered without increasing medical risk to appointees.

Methods: This retrospective, epidemiological, cross-sectional single-center study spanned 5 years at the French paratroopers' initial training center. We analyzed all medical files and full-spine X-ray results of all enlisted troops during this period. Secondary evaluation by an orthopedic surgeon enabled 23 enlisted personnel, deemed medically unacceptable because of X-ray findings, to be given waivers for airborne training. A follow-up review of their 23 files was conducted to determine whether static-line parachute jumps were hazardous to those who were initially declared medically unacceptable.

Results: Of the 3,993 full-spine X-rays, 67.5% (2,695) were described as having normal alignment and structure; 21.8% (871) had lateral spinal deviation; and 10.7% (427) had scoliosis. Sixty-six recruits (1.6%) were deemed unfit because of findings that did not meet the standard on the fullspine X-ray: 53 enlisted personnel had scoliosis greater than 15°, and 13 had spondylolisthesis (grade II or III). Of the 23 patients granted waivers, 82.3% with scoliosis (14) and all patients with kyphosis had not declared any back pain after 5 years.

Conclusion: The findings, supported by a literature review of foreign military data, suggest that spondylolisthesis above grade I and low back pain are more significant than scoliosis and kyphosis for establishing airborne standards.

Herein, we present a simplified approach to prehospital mass casualty event (MASCAL) management called "Move, Treat, and Transport." Prior publications demonstrate a disconnect between MASCAL response training and actions taken during real-world incidents. Overly complex algorithms, infrequent training on their use, and chaotic events all contribute to the low utilization of formal triage systems in the real world. A review of published studies on prehospital MASCAL management and a recent series of military prehospital MASCAL responses highlight the need for an intuitive MASCAL management system that accounts for expected resource limitations and tactical constraints. "Move, Treat, and Transport" is a simple and pragmatic approach that emphasizes speed and efficiency of response; considers time, tactics, and scale of the event; and focuses on interventions and evacuation to definitive care if needed.

Biting sandflies are known for transmitting leishmaniasis, but sandflies also transmit sandfly fever viruses that may disrupt military operations. Sandfly fever is caused by serotypes of the Phlebovirus genus (primarily the Naples, Sicilian, or Toscana serotypes). The illness is known colloquially as "three-day fever" and "papataci fever." The clinical course of the disease normally spans about 3 days, with patients exhibiting a prodromal phase consisting of fatigue, chills, abdominal pain, and possibly facial flushing and tachycardia. Disease onset is marked by hyperpyrexia, myalgia, and arthralgia. The incubation period is typically 3-5 days, with viremia in humans lasting typically less than 1 week. This manuscript describes sandfly appearance, behavior, and geographic distribution. It then lists comparable diseases for differential diagnosis. Finally, as no vaccine exists for the sandfly virus, it concludes with steps for preparation and prevention to prevent outbreaks from disrupting military operations.

Despite advancements in military medical treatment and evacuation, soldiers in austere environments remain vulnerable to disease and non-battle injury and may face prolonged evacuation before receiving definitive care. In particular, arranging care for a soldier presenting with a conditions that has a wide differential diagnosis, such as acute altered mental status (AMS), can be especially challenging. We highlight the case of an otherwise young, healthy U.S. Soldier serving in Indonesia, who presented with acute AMS concerning for undifferentiated infection. Subsequent workup at the receiving hospital following evacuation revealed Salmonella enterica infection, more commonly known as typhoid. However, even with clinical findings of typhoid encephalitis and initiation of empiric treatment, medical care proved challenging in the resource-limited local facilities, despite multiple escalations of care. Ultimately, the patient was evacuated to a tertiary facility in Singapore, where his condition improved, and 4 days after initial presentation the patient had no definitive findings of infections on lumbar puncture. This case not only highlights the threat of typhoid and other infectious diseases in modern operations but also the challenges of suboptimal medical care in both the prehospital and hospital settings when utilizing host nation facilities.

Tattooing is an ancient art form widely practiced among Special Operations Forces (SOF) personnel. The ink injected into skin tissue during tattooing often contains various compounds, including impurities and contaminants, which can pose health risks. This article provides an overview of recent research to inform SOF medical personnel about the potential health implications of both new and older tattoos.

Background: In emergency casualty and evacuation situations, manual ventilation using self-inflating bags remains a critical skill; however, significant challenges exist in ensuring safety and effectiveness, since inaccurate manual ventilation is associated with life-threatening risks (e.g., gastric insufflation with aspiration, barotrauma, and reduced venous return).

Methods: This study assessed the impact of audiovisual feedback from the bag-valve-mask (BVM) emergency narration guided instrument (BENGI), a handheld manual ventilation guidance device, on improving performance and safety, immediately and 2 weeks after, with no additional manual ventilation training. In a crossover manikin simulation study with 20 participants, BENGI immediately and significantly improved tidal volume and respiratory rate accuracy.

Results: Intraand inter-participant variations were lower with BENGI, with Poincaré plot analysis showing improved performance that remained for at least 2 weeks following BENGI training.

Conclusion: BENGI's audiovisual feedback improves manual immediately and persistently, making it invaluable for training and clinical use in diverse scenarios, from battlespace to civilian emergencies.

Special Forces increasingly operate in austere environments, which are known to have limited medical support and prolonged evacuation times. On the battlefield, pain remains the first complaint of casualties and can impact direct autonomic stability, recovery, and the development of posttraumatic stress disorder. Although medical education has been improving, medical providers still encounter difficulties, such as lack of human and material resources, while trying to achieve pain management. This article summarizes a survey sent to 35 Special Operations medical providers and suggests possible strategies to address challenges to pain management on the battlefield. Potential solutions have been gathered through medical texts, medical/NATO documents, and medical expertise. Nerves blocks have been identified as valuable tools for pain management in the current battlefield environment, where prolonged evacuation and limited freedom of movement are the norm. The survey showed that, although the vast majority of providers had already received lectures on regional anesthesia, 83% were not trained in it, and 54% had never been made aware of multimodal analgesia. This lack of familiarity highlights knowledge and training gaps in nerve block techniques. Diffusion blocks are a very low-risk, useful, and safe pain management technique, which requires less skill sustainment and resources than more complex techniques. The use of epinephrine as adjunct can be useful for decreasing local anesthetic toxicity and increasing long-term pain management. The need for both education on and training in the use of nerve blocks has been identified by the Special Operations health provider community.